HIV ribbon

The study, published in The Lancet Infectious Diseases, was conducted by researchers at the University College London (UCL) and the World Health Organisation (WHO), and was funded by the Bill & Melinda Gates Foundation and the WHO. It evaluated over 350 datasets, which included the data from 56,044 adults who were at the start of first-line therapy for HIV between the years of 1996–2016.

In the meta-analysis, the researchers found that resistance – particularly to one of the main types of first-line drug, non-nucleoside reverse transcriptase inhibitors (NNRTIs) — is on the rise. Additionally, those who exhibited drug resistance were more likely to have previously been exposed to antiretroviral drugs, often during pregnancy.

“Treatments for HIV have improved immensely in recent years, and close to 21 million people worldwide are now being treated with antiretroviral therapy.* Yet to end the AIDS epidemic as a public health threat, minimising drug resistance will be one part of the response. Our findings show the importance of improving how we monitor drug resistance, and suggest we should review which drugs are included in first-line therapies,” said the study’s lead author, Professor Ravindra Gupta (UCL Infection & Immunity).

This study specifically focussed on low- to middle-income countries and not high-income countries. Although, other research has demonstrated that drug resistance to NNRTIs in high-income countries is plateauing or declining.

“Many people develop drug resistance after being treated by antiretroviral drugs if they stop taking their medication — often due to personal reasons, difficulty accessing treatment providers, or drug supply issues that are common in low-income regions. When these individuals restart treatment at a later date, they are less likely to respond to therapy and may pass on the drug-resistant strains to other people,” explained Gupta.

“If we are to combat HIV drug resistance, we must ensure countries can do a good job in monitoring and responding to it when needed,” said co-author Dr Silvia Bertagnolio of the World Health Organization. “New WHO guidelines and a global action plan aim to help make this happen.”